Find policies, billing codes, payers, states, and providers
CPT 97750: Physical Performance Evaluation and Functional Assessment
CPT code 97750 designates a formal physical performance evaluation in which a clinician assesses musculoskeletal function and activities of daily living and documents findings in a written report. This evaluation is used to quantify functional capacity, guide care planning, and support clinical and administrative decisions. Nationally, the code matters for standardizing how functional assessments are billed across rehabilitation and outpatient settings, affecting coverage, utilization oversight, and care coordination.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Readers will find an overview of the code’s clinical role, comparisons to related evaluation and testing codes, common settings where the service is delivered, and payer coverage considerations. The publication summarizes typical use cases—such as assessing gait, transfer ability, endurance, and task-specific performance—and situates 97750 alongside related rehabilitation services.
The analysis provides benchmarks for utilization patterns and common billing contexts, explains documentation elements tied to the written report requirement, and highlights clinical scenarios where the evaluation is commonly applied. Policy and coverage nuances from major national payers are summarized to inform coding accuracy and administrative workflows. Data not available in the input is noted where applicable.
Customize your policy alerts
Sign up for cpt 97750 policy alerts
Get alerted when payer policies referencing 97750 are released or updated.
Monitor payer policy activity
Billing Code Overview
CPT code 97750 describes a physical performance evaluation in which the provider assesses a patient’s musculoskeletal and functional capacity through standardized tests and observation of activities of daily living. The service includes evaluation of physical performance and completion of a written report documenting findings and functional implications.
Service type: Functional performance assessment / Physical performance evaluation
Typical site of service: Outpatient rehabilitation clinic, outpatient hospital department, or other ambulatory care settings where physical or occupational performance testing is performed
National Reimbursement Benchmarks
Medicare's national mean of $35 sits below BUCA's commercial average of $52.6, indicating that average commercial reimbursements for CPT 97750 exceed Medicare by about $17.6. The median Medicare local rate is $34 while BUCA's median is $45.7, further underscoring higher central tendency in BUCA commercial arrangements versus Medicare locality averages.
Dispersion varies materially across payers: Blue Cross Blue Shield shows the widest interquartile spread with P75–P25 = $31.2 ($75.5–$46.3), followed by UnitedHealth Group at $14.9 ($44.9–$30.4). Aetna displays a relatively tight spread of $9.0 ($31.0–$22.0), and Cigna's spread is $25.1 ($52.5–$27.4). BUCA's IQR is $22.6 ($61.5–$37.9) and Medicare's IQR is $3 ($36–$33), making Medicare the tightest by this measure.